手术导航定位系统在高血压脑出血穿刺引流中的应用

魏守元 耿涛 刘龙生

【摘要】 目的：探讨老年高血压脑出血（HICH）患者应用神经外科手术导航定位系统辅助定位微创软通道血肿穿刺引流术治疗的临床价值，分析其安全性。方法：回顾性分析2023年1—10月黔西南州人民医院收治的86例老年（年龄≥60岁）HICH患者的临床资料，所有病例均有明确手术指征，且采用微创软通道血肿穿刺引流术。根据辅助定位方式进行分组，采用常规CT检查定位法的43例患者为对照组，采用RM-200型神经外科手术导航定位系统辅助定位的43例患者为观察组。比较两组手术时间、术中失血量、引流管拔除时间、血肿清除情况、美国国立卫生研究院卒中量表（NIHSS）评分、格拉斯哥昏迷量表（GCS）评分、并发症发生情况。结果：观察组手术时间短于对照组，引流管拔除时间早于对照组，术中失血量少于对照组，差异均有统计学意义（P<0.05）。观察组NIHSS评分低于对照组，GCS评分高于对照组，并发症总发生率低于对照组，差异均有统计学意义（P<0.05）。术后1、3 d，观察组血肿清除率均高于对照组，差异均有统计学意义（P<0.05）；术后5 d，两组血肿清除率差异无统计学意义（P>0.05）。结论：在老年HICH患者行微创软通道血肿穿刺引流术治疗中，采用手术导航定位系统辅助定位能够提高手术效率，改善短期内血肿清除情况，降低术中失血量与术后并发症发生风险，且对患者昏迷症状、神经功能损伤的早期改善也有积极影响。

【关键词】 高血压脑出血 神经外科手术导航定位系统 微创软通道血肿穿刺引流术 血肿清除率

Application of Surgical Navigation and Positioning System in Puncture and Drainage of Hypertensive Intracerebral Hemorrhage/WEI Shouyuan， GENG Tao， LIU Longsheng. //Medical Innovation of China， 2024， 21（14）： 0-031

[Abstract] Objective： To explore the clinical value of applying minimally invasive soft-channel haematoma puncture and drainage with neurosurgical navigation and positioning system-assisted positioning in elderly hypertensive intracerebral hemorrhage （HICH） patients， and to analyse its safety. Method： The clinical data of 86 elderly patients （aged ≥60 years） with HICH admitted to Qianxinan People's Hospital from January to October 2023 were retrospectively analyzed， all patients had clear surgical indications and underwent minimally invasive soft-channel hematoma puncture and drainage. According to the auxiliary positioning methods， 43 patients with conventional CT examination and positioning method were selected as the control group， and 43 patients with RM-200 neurosurgery navigation and positioning system assisted positioning were selected as the observation group. Operation time， intraoperative blood loss， drainage tube removal time， hematoma clearance， national institutes of health stroke scale （NIHSS） score， Glasgow coma scale （GCS） score， and complications were compared between the two groups. Result： The operation time of the observation group was shorter than that of the control group， the drainage tube removal time was earlier than that of the control group， and the intraoperative blood loss was less than that of the control group， the differences were statistically significant （P<0.05）. The NIHSS score and GCS score of the observation group were lower than those of the control group， and the total incidence of complications was lower than that of the control group， the differences were statistically significant （P<0.05）. 1 and 3 d after operation， the hematoma clearance rates in the observation group were higher than those in the control group， the differences were statistically significant （P<0.05）; 5 d after operation， there was no significant difference in the clearance rate of hematoma between the two groups （P>0.05）. Conclusion： In the treatment of minimally invasive soft-channel hematoma puncture and drainage in elderly patients with HICH， assisted positioning by surgical navigation and positioning system can improve the efficiency of surgery， improve the clearance of hematoma in the short term， reduce the intraoperative blood loss and the risk of postoperative complications， and also have a positive impact on the early improvement of coma symptoms and neurological function injury.

[Key words] Hypertensive intracerebral hemorrhage Neurosurgical navigation and positioning system Minimally invasive soft-channel hematoma puncture and drainage Hematoma clearance rate

First-author's address： Neurosurgery Department， Qianxinan People's Hospital， Xingyi 562400， China

doi：10.3969/j.issn.1674-4985.2024.14.007

高血压脑出血（HICH）是高血压患者较严重的并发症之一，主要指非外伤性脑实质内出血，具有起病急骤、致死风险高等特点[1]。受血压水平过高的长期影响，患者的血管壁脆性可显著增加，出现张力丧失、痉挛等问题，在体力劳动、情绪激动等刺激因素的作用下，可能发生血管破裂。……